Posterior subthalamic area deep brain stimulation for recurrent tremor after ventral intermediate nucleus thalamotomy: a case report

Neurosurgical treatment is considered as an effective treatment option for patients with essential tremor (ET), since approximately 50% of the ET population is refractory to medical treatment [1]. Historically, various methods, from ablative procedures to deep brain stimulation (DBS) have been used, each having its own strengths and weaknesses. With the recent development of magnetic resonance guided focused ultrasound (FUS), a new trend in the lesioning procedure for ET has emerged [2]. Although each treatment can be complementary to each other, clinicians inevitably face difficulties in deciding which surgical technique to use or which target needs to be operated on for the second treatment. In recurrent case after lesioning procedure, it is uncertain whether stimulating previously injured neural structures can achieve the same effectiveness to control tremor. Moreover, it is uncomfortable to set the intracranial surgical tract due to thalamic scarring during the DBS. In contrast, lesioning after failed DBS can be very burdensome to ablate nearby areas with electrical devices. Here, we present a case of recurrent tremor after ablation of the ventral intermediate nucleus of the thalamus (VIM), which was effectively managed with posterior subthalamic area (PSA) DBS, and review previous reports with similar experiences. Posterior subthalamic area deep brain stimulation for recurrent tremor after ventral intermediate nucleus thalamotomy: a case report